Reason Code: 55HTP
Error Description:
Home Health: The initial certification was missing/incomplete/invalid; therefore, the recertification episode is denied.
Avoiding/Correcting This Error
Verify that the initial certification is complete and includes all necessary elements, such as the patient’s homebound status, the need for skilled services, and a face-to-face encounter with a physician or allowed nonphysician practitioner. Ensure that the initial certification is obtained and signed by the physician before the start of home health services and keep it on file for future recertifications. Documentation should include a clear narrative justifying the medical necessity for home health services, and must be legible, containing the date, provider signature and all required content. The certification must be completed by a physician or NPP and the required face-to-face encounter must occur within 90 days prior to or 30 days after the start of home health care.